Viral Hepatitis: B and D Flashcards
Define Viral Hepatitis?
Hepatitis caused by infection with HBV, which may follow an acute or chronic course
What is Chronic Viral Hepatitis?
Defined as viraemia and hepatic inflammation continuing for > 6 months
What is HDV?
It is a defective virus, that may only co-infect with HBV or superinfect people who are already carriers of HBV
What is HBV?
It is an enveloped, partially double-stranded DNA virus
What is the transmission of HBV?
Sexual contact
Blood
Vertical transmission (from mother to baby)
What viral proteins are produced in HBV?
Core antigen (HBcAg) Surface antigen (HBsAg) e antigen (HBeAg)
What is the significance of the e antigen (HBeAg)?
It is a marker of high infectivity
What is HDV?
It is a single-stranded RNA virus coated with HBsAg
What is the aetiology of HDV?
Antibody and cell-mediated immune response to viral replication leads to liver inflammation and hepatocyte necrosis
Histology can show mild to severe inflammation and changes to cirrhosis
What are the risk factors of HDV?
IV drug use
Unscreened blood and blood products
Infants of HBeAg-positive mothers
Sexual contact with HBV carriers
Younger individuals (particularly babies) are more likely to become chronic carriers
Genetic factors are associated with varying rates of viral clearance
What is the epidemiology of HBV and HDV?
Common
1-2 million deaths annually
Common in SE Asia, Africa and Mediterrean countries
HDV is also found worldwide
What is the incubation period for HBV and HDV?
3-6 months
What are the presenting symptoms in the 1-2 week prodrome for HBV and HDV?
Malaise Headache Anorexia Nausea and vomiting Diarrhoea RUQ pain Serum-sickness type illness
What are some of the symptoms associated with Serum-sickness type illness?
Fever Arthralgia Polyarthritis Urticaria Maculopapular rash
What is another symptom of HBV and HDV?
Jaundice develops with dark urine
How long does it take to recover from HBV and HDV?
4-8 weeks
What percentage of patients with HBV and HDV develop fulminant liver failure?
1%
What are the Acute signs of HBV and HDV?
Jaundice
Pyrexia
Tender hepatomegaly
Splenomegaly
Cervical lymphadneopathy (in 10-20% of patients)
Occsaionally: urticaria and maculopapular rash
What are the chronic signs of HBV and HDV?
May be no findings
May have signs of chronic liver disease or decompensation
What investigations do you do for HBV and HDV?
Viral Serology
LFTs
Clotting
Liver Biopsy
What Viral Serology tests do we see for Acute HBV?
HBsAg positive
IgM anti-HBcAg
What Viral Serology tests do we see for Chronic HBV?
HBsAg positive
IgG anti-HBcAg
HBeAg positive or negative
What viral serology tests do we do for HBV cleared or vaccinated against HBV patients?
Anti-HBsAg antibody positive
IgG anti-HBcAg
What viral serology tests do we see for an HDV infection?
Detected by IgM or IgG against HDV
PCR is used for detection of HDV
What do we look for on the LFTs for HBV and HDV?
HIGH: AST ALT ALP Bilirubin
What clotting test do we do for HBV and HDV?
High PT (in severe disease)
What prevention do we do for HBV and HDV?
Blood screening
Safe sex
Instrument sterilisation
What is the Passive Immunisation for HBV and HDV?
Hepatitis B Immunoglobulin following acute exposure and to neonates born to HBeAg-positive mothers (in addition to active immunisation)
What is the Active Immunisation for HBV and HDV?
Recombinant HBsAg vaccine for individuals at risk and neonates born to HB
What is the mananagement plan for Acute HBV Hepatitis?
Symptomatic treament (antipyretics, antiemetics and cholestyramine) and bed rest Notifiable disease
What is the management plan for Chronic HBV?
Interferon alpha (standard or pegylated) Nucleoside/nucleotide analogues (adefovir, entercavir, telbivudine, tenofovir)
What are the side effects of Interferon alpha in the treatment of Chronic HBV?
Flu-like symptoms such as fever, chills, myalgia, headaches, bone marrow suppression and depression
What are the possible complications of HBV and HDV?
1% get fulminant hepatic failure
Chronic HBV infection (10% of adults, much higher in neonates)
Cirrhosis
HCC
Extrahepatic immune complex disorders (e.g. glomerulonephritis, polyarteritis nodosa)
Superinfection with HDV may lead to acute liver failure or more rapidly progressive disease
What is the prognosis of patients with HBV and HDV?
Adults: 10% of infections become chronic
Of the chronic infections, 20-30% will develop cirrhosis
